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General NPI Number Information
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NPI Number | 1093250524
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Entity Type | Individual
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Provider Name | MINDY SWANSON LPC
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Gender | Female
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 25 E BROAD ST
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City | NEWNAN
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State | GA
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Zip | 30263-1922
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Country | US
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Telephone | 770-988-4612
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Fax |
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Provider Business Mailing Address
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Address Line | 174 BRAELINN CT
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2140
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Country | US
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Telephone | 770-713-5858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC009344
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License Number State | GA
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